Breast reconstruction with latissimus dorsi flap: a comprehensive review and case series

Joseph M Escandón; Oscar J Manrique; Jose G Christiano; Vanessa Mroueh; Peter A Prieto; Jessica C Gooch; Anna Weiss; Howard N Langstein

doi:10.21037/atm-23-469

Breast reconstruction with latissimus dorsi flap: a comprehensive review and case series

Ann Transl Med. 2023 Aug 30;11(10):355. doi: 10.21037/atm-23-469. Epub 2023 May 24.

Authors

Joseph M Escandón¹, Oscar J Manrique¹, Jose G Christiano¹, Vanessa Mroueh², Peter A Prieto³, Jessica C Gooch³, Anna Weiss³, Howard N Langstein¹

Affiliations

¹ Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY, USA.
² American University of Beirut Faculty of Medicine, Beirut, Lebanon.
³ Division of Surgical Oncology, Department of Surgery, Pluta Cancer Center, Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, USA.

Abstract

The latissimus dorsi flap (LDF) has gained popularity given its versatile nature and broad applicability in breast reconstruction. Its resurgence has been attributed to its ability to be enhanced using implant or high-volume fat grafting, rendering it a primary option for selected patients. The aim of this review is to tackle current indications and subjects of controversy regarding use of complete-autologous and implant-enhanced LDF in breast reconstruction. Also, a case-series showcasing the authors' experience with this versatile reconstructive option is presented. A search across Web of Science and PubMed MEDLINE from inception through January 3, 2023, was conducted. Articles reporting postoperative outcomes of autologous breast reconstruction with LDF were included. Regarding the case series, electronic medical records of patients who underwent total mastectomy and autologous breast reconstruction with LDF from January 2011 to December 2021 were retrospectively reviewed. Data on demographic and oncologic characteristics, and surgical characteristics and outcomes were extracted. Our review suggests that LDF is suitable for patients who lack alternative donor site, have a history of abdominoplasty or no access to microsurgery, smokers or obese. Latissimus dorsi (LD) harvesting has almost complete shoulder function recovery in the long-term. Thoracodorsal nerve division does not cause volume loss or animation deformity. Multisite multilayer fat grafting, beveling the edges of the skin paddle and fat, folding the LD muscle and plicating the paddle allow adequate projection and contour achievement. Our case-series included 234 reconstructions. Almost half of the patients had immediate fat transfer during reconstruction (51.3%). The rate of recipient site hematoma was 3.0%, seroma was 7.7%, wound disruption 32.1%, wound disruption events requiring unplanned procedures was 13.7%, and surgical site infection (SSI) was 12.4%. The LDF is reliable and safe for immediate or delayed breast reconstruction or salvage after reconstruction failure. Its versatility, reliable anatomy, easy dissection, and relative low complication rate have revived this modality as valuable opportunity for breast reconstruction in this era.

Keywords: Female; breast; myocutaneous flap; superficial back muscles; treatment outcome.

Publication types

Review